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A Solid Start

Recently, I perused my childhood medical records. I noticed that at my 6-week checkup with the pediatrician, my mother was advised to begin feeding me rice cereal. At 6 weeks of age! Once upon a time, that was the standard advice: Start your baby on solids as soon as possible. But new insights into the art and science of infant feeding reveal that it's much wiser to wait.

Around 6 months, babies are physically and developmentally ready to take their first bites (or slurps or licks) of solid food. That's why, in my practice, at their babies' 6-month checkups, I get so many questions from new parents about the whats, hows, and whens of infant feeding. Here are some of my answers:

6 to 9 Months

How will I know when my baby is ready to eat?

If your baby reaches for your food or follows your fork with his eyes as it moves from your plate to your mouth, he's probably ready for some solid food of his own.

But often, the only way to tell is to try. Use your fingertip as your baby's first spoon. Place a fingertipful of food on his lips and let him suck on it. Then try placing a small glob of food toward the middle of his tongue and watch his reaction. If the food goes in, followed by a smile, your baby is ready and willing. If the food quickly comes back, along with a grimace, your baby may need to wait. Put the food away and try again next week.

With which foods should I start?

Favorite first foods are mashed bananas (the sweet taste is similar to that of breast milk), mashed cooked pears, iron-fortified rice or barley cereal (because it is gluten-free, rice is often more friendly to maturing intestines than wheat), applesauce, mashed cooked carrots, mashed sweet potatoes, mashed winter squash, pureed peas and green beans, and, in my opinion, the most nutritious of early solid foods, mashed avocado.

After the first food, wait three to five days before introducing a new one to see if your baby develops an allergic reaction, including a red rash on the face or bottom, diarrhea, persistent runny nose, or colicky abdominal pain.

Remember, your goal is to introduce your baby to solid foods, not to fill her up. Breast milk or formula should remain the primary source of nutrition for the the first year.

What are the best finger foods and when can I begin giving them to my baby?

Around 9 months, you can begin feeding finger foods such as rice cake pieces, O-shaped cereals, tofu strips, egg yolk crumbles, cooked noodles, and small pieces of cooked fruit or soft, ripe avocado. During teething, babies like to mouth teething biscuits to soothe their sore gums. Avoid choking hazards like raw fruits and vegetables, nuts, seeds, grapes, hot dogs, and meat chunks.

My baby seems uncomfortable with eating solids. How can I make it easier for her?

Expect erratic eating patterns. Your baby may take one tablespoon at one feeding and only a teaspoon at the next. Whatever you do, don't force-feed. One of the earliest obesity-prevention measures is for your baby to learn to control her own food portions. Watch for what I call "stop signs," and back off from a feeding if your baby purses her lips, closes her mouth, or turns away from the advancing spoon. To help make your baby more receptive to a feeding, though, capitalize on her desire to mimic. Eat the baby food yourself and exaggerate your enjoyment of it  -- your baby may beg for her own bite. If she has trouble getting food off the spoon, try the upper lip sweep: Gently lift the spoon upward as you pull it out of her mouth, allowing her upper lip to sweep off the food.

Does it matter when I feed my baby?

Usually not. But choose a time of the day when you're not in a hurry, since spattering, smearing, and dropping are all part of the feeding game. If breastfeeding, offer food toward the end of the day when your milk supply tends to be lowest and your baby may be more eager to eat. Otherwise, offer new foods in the morning, which is usually when babies are the hungriest.

9 to 12 Months

Should I worry about my child's table manners?

No. Allow your baby the luxury of playing around a little bit. Between 9 and 12 months of age, babies become enthralled with poking at food, so expect your young artist to begin finger-painting with his applesauce. Enjoy his "art," as this stage will soon pass.

You can discourage food flinging by putting only a few pieces of food in front of him instead of a whole pile. And don't laugh when your baby drops food; your apparent delight will only reinforce his habit.

When should I introduce drinking from a cup, and which drinks should I offer?

Sometime between 9 and 12 months, your baby may enjoy the variety of a cup. Begin with water or breast milk/formula, filling the cup only a quarter full until your baby's cup skills mature. Consider juice only as a delivery system for extra water, which your baby needs once she is eating a lot of solids. White grape juice is the most intestine-friendly juice, but, above all, stick with 100 percent fruit juice and avoid those sweetened with sugar and corn syrup. Since juice is not nutrient-dense, limit it to four to six ounces per day between 6 and 12 months and six ounces a day from 1 to 2 years. Avoid introducing cow's milk before your baby is 1. Her intestinal lining may not be fully mature, and you run the risk of allergies.

Is it okay to feed my baby a vegetarian diet?

Yes, as long as you take some dietary precautions to be sure your growing child gets enough nutrients. A strict vegetarian diet can be low in iron, zinc, calcium, vitamin D, vitamin B12, and other B vitamins. For this reason, talk to your doctor about giving your child a daily multivitamin/multimineral preparation.

My main concern about vegetarianism for children is the possible deficiency of essential fats, namely the brain-building omega-3 fats found in some fish (especially salmon), so consider a pesco-vegetarian diet for your child, which allows for seafood. Avoid shark, swordfish, king mackerel, and tilefish, which have been shown to contain high levels of mercury, however, and limit your child's fish intake to about four ounces per week. Also, get your baby used to tofu, a nutritious meat substitute.

How can I be sure my child is getting enough iron?

Iron is necessary to make hemoglobin in a baby's red blood cells and is important for optimal neurological development. To insure your baby has enough of it, breastfeed or use an iron-fortified formula for at least a year or as long as your doctor recommends it. An iron-enriching trick: Serve foods rich in vitamin C with foods high in iron (spaghetti with meat and tomato sauce, for example). The vitamin C increases the amount of iron absorbed from the food. Meat is the best source of iron, but other good sources are iron-fortified cereals, mashed sweet potatoes, prune juice, beans, lentils, and tofu.

12 to 24 Months

My baby is chubby. Does that mean he will be overweight as a child or adult?

There is some evidence that babies who are above their weight percentiles are at a greater risk for obesity in later life. But most chubby babies go through a natural leaning-out stage between ages 1 and 2. For all babies, no matter what their size, think in terms of a "right fat" diet instead of a low fat one. Besides being the richest source of food energy, fats are a vital part of every growing organ, especially the brain. Unfortunately, a lot of babies get too many of the wrong fats and not enough of the right ones. Look out for saturated fats, listed as "partially hydrogenated oils" in some cereals, crackers, and fast foods. The best fats for growing bodies and brains are the omega-3 fats found in salmon and other oily fish. Get your baby used to the taste of salmon by camouflaging it under applesauce.

Should I stay away from feeding my child any sugar?

How sugars behave in your baby's body depends upon how fast they are absorbed into the bloodstream. The sugars found in complex carbohydrates such as vegetables, fruits, and whole grains take a longer time to digest and provide a steady supply of energy rather than the rollercoaster highs and lows caused by the simple sugars found in candy, soda, and packaged snack food. While you want to limit those simple sugars, kids need the energy provided by complex carbohydrates to play and learn.

My 2-year-old is a very picky eater. How can I be sure she eats enough?

This is a very common worry for parents of toddlers, though it needn't be. If your child is growing and gaining weight well, then she's getting enough calories and eating plenty. Kids this age don't eat a lot because they don't grow as fast, so try not to worry about whether she clears her dinner plate. Encourage your child to try new foods with a few tips from the Sears' family kitchen:

Create a nibble tray. Use an ice cube tray or muffin tin and put bite-size portions of colorful, nutritious foods in each compartment.

Make mini meals. Instead of eating three large meals, encourage your toddler to sit down at the table frequently for small, healthy snacks.

Top it off. Top new or less desirable foods with familiar favorites like yogurt, melted cheese, or applesauce to broaden the finicky toddler's menu. It may take 10 to 15 exposures until a baby accepts a new food.

Contributing editor William Sears, M.D., is the author of 30 books on childcare, including the newly revised and updated version of The Baby Book.

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